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General NPI Number Information
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NPI Number | 1780593863
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Entity Type | Organization
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Legal Business Name | IK PERIO PLLC
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 131 MAIN ST
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City | WALTHAM
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State | MA
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Zip | 02453-6636
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Country | US
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Telephone | 781-647-0618
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Fax |
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Provider Business Mailing Address
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Address Line | 131 MAIN ST
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City | WALTHAM
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State | MA
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Zip | 02453-6636
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER PERIODONTIST
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Name | DR. ISAAC KIM
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Credential | DMD
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Telephone | 617-583-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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